. 2025 Oct 1;20(10):1323-1340.

doi: 10.2215/CJN.0000000773. Epub 2025 Aug 5.

The Association of Long COVID and CKD: Findings from the National Clinical Cohort Collaborative

A Jerrod Anzalone¹, Spencer Krichevsky², Yun Jae Yoo³, Kenneth J Wilkins⁴, Fadhl Alakwaa⁵, Feifan Liu⁶, Ankit Sakhuja⁷, Joel H Saltz², Yun Han⁵, Richard L Zhu⁸, Soko Setoguchi⁹, Sandra L Kane-Gill¹⁰, Sandeep K Mallipattu^{11

12}, Yongqun He¹³, David H Ellison¹⁴, James Brian Byrd¹⁵, Chirag R Parikh¹⁶, Rajiv Saran¹⁷, Richard A Moffitt³, Farrukh M Koraishy¹¹; National Clinical Cohort Collaborative (N3C) Consortium and the RECOVER EHR Cohort

Collaborators, Affiliations

Collaborators

National Clinical Cohort Collaborative (N3C) Consortium and the RECOVER EHR Cohort:
Adam B Wilcox, Adam M Lee, Alexis Graves, Alfred Jerrod Anzalone, Amin Manna, Amit Saha, Amy Olex, Andrea Zhou, Andrew E Williams, Andrew Southerland, Andrew T Girvin, Anita Walden, Anjali A Sharathkumar, Benjamin Amor, Benjamin Bates, Brian Hendricks, Brijesh Patel, Caleb Alexander, Carolyn Bramante, Cavin Ward-Caviness, Charisse Madlock-Brown, Christine Suver, Christopher Chute, Christopher Dillon, Chunlei Wu, Clare Schmitt, Cliff Takemoto, Dan Housman, Davera Gabriel, David A Eichmann, Diego Mazzotti, Don Brown, Eilis Boudreau, Elaine Hill, Emily Carlson Marti, Emily R Pfaff, Evan French, Farrukh M Koraishy, Federico Mariona, Fred Prior, George Sokos, Greg Martin, Harold Lehmann, Heidi Spratt, Hemalkumar Mehta, J W Awori Hayanga, Jami Pincavitch, Jaylyn Clark, Jeremy Richard Harper, Jessica Islam, Jin Ge, Joel Gagnier, Johanna Loomba, John Buse, Jomol Mathew, Joni L Rutter, Julie A McMurry, Justin Guinney, Justin Starren, Karen Crowley, Katie Rebecca Bradwell, Kellie M Walters, Ken Wilkins, Kenneth R Gersing, Kenrick Dwain Cato, Kimberly Murray, Kristin Kostka, Lavance Northington, Lee Allan Pyles, Lesley Cottrell, Lili Portilla, Mariam Deacy, Mark M Bissell, Marshall Clark, Mary Emmett, Matvey B Palchuk, Melissa A Haendel, Meredith Adams, Meredith Temple-O'Connor, Michael G Kurilla, Michele Morris, Nasia Safdar, Nicole Garbarini, Noha Sharafeldin, Ofer Sadan, Patricia A Francis, Penny Wung Burgoon, Philip R O Payne, Randeep Jawa, Rebecca Erwin-Cohen, Rena Patel, Richard A Moffitt, Richard L Zhu, Rishi Kamaleswaran, Robert Hurley, Robert T Miller, Saiju Pyarajan, Sam G Michael, Samuel Bozzette, Sandeep Mallipattu, Satyanarayana Vedula, Scott Chapman, Shawn T O'Neil, Soko Setoguchi, Stephanie S Hong, Steve Johnson, Tellen D Bennett, Tiffany Callahan, Umit Topaloglu, Valery Gordon, Vignesh Subbian, Warren A Kibbe, Wenndy Hernandez, Will Beasley, Will Cooper, William Hillegass, Xiaohan Tanner Zhang, Leyna Aragon, Etienne Carignan

Affiliations

¹ Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
² Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York.
³ Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.
⁴ Biostatistics Program, Department of Preventive Medicine and Biostatistics, National Institute of Diabetes and Digestive and Kidney Diseases, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
⁵ Nephrology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
⁶ Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
⁷ Division of Data Driven and Digital Medicine, Department of Medicine, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
⁸ Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁹ Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, New Jersy.
¹⁰ Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania.
¹¹ Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York.
¹² Northport VAMC, Northport, New York.
¹³ Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan.
¹⁴ Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, Oregon.
¹⁵ Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
¹⁶ Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
¹⁷ Division of Nephrology, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, Michigan.

PMID: 40762975
PMCID: PMC12537286 (available on 2026-10-01)
DOI: 10.2215/CJN.0000000773

The Association of Long COVID and CKD: Findings from the National Clinical Cohort Collaborative

A Jerrod Anzalone et al. Clin J Am Soc Nephrol. 2025.

. 2025 Oct 1;20(10):1323-1340.

doi: 10.2215/CJN.0000000773. Epub 2025 Aug 5.

Authors

Collaborators

National Clinical Cohort Collaborative (N3C) Consortium and the RECOVER EHR Cohort:
Adam B Wilcox, Adam M Lee, Alexis Graves, Alfred Jerrod Anzalone, Amin Manna, Amit Saha, Amy Olex, Andrea Zhou, Andrew E Williams, Andrew Southerland, Andrew T Girvin, Anita Walden, Anjali A Sharathkumar, Benjamin Amor, Benjamin Bates, Brian Hendricks, Brijesh Patel, Caleb Alexander, Carolyn Bramante, Cavin Ward-Caviness, Charisse Madlock-Brown, Christine Suver, Christopher Chute, Christopher Dillon, Chunlei Wu, Clare Schmitt, Cliff Takemoto, Dan Housman, Davera Gabriel, David A Eichmann, Diego Mazzotti, Don Brown, Eilis Boudreau, Elaine Hill, Emily Carlson Marti, Emily R Pfaff, Evan French, Farrukh M Koraishy, Federico Mariona, Fred Prior, George Sokos, Greg Martin, Harold Lehmann, Heidi Spratt, Hemalkumar Mehta, J W Awori Hayanga, Jami Pincavitch, Jaylyn Clark, Jeremy Richard Harper, Jessica Islam, Jin Ge, Joel Gagnier, Johanna Loomba, John Buse, Jomol Mathew, Joni L Rutter, Julie A McMurry, Justin Guinney, Justin Starren, Karen Crowley, Katie Rebecca Bradwell, Kellie M Walters, Ken Wilkins, Kenneth R Gersing, Kenrick Dwain Cato, Kimberly Murray, Kristin Kostka, Lavance Northington, Lee Allan Pyles, Lesley Cottrell, Lili Portilla, Mariam Deacy, Mark M Bissell, Marshall Clark, Mary Emmett, Matvey B Palchuk, Melissa A Haendel, Meredith Adams, Meredith Temple-O'Connor, Michael G Kurilla, Michele Morris, Nasia Safdar, Nicole Garbarini, Noha Sharafeldin, Ofer Sadan, Patricia A Francis, Penny Wung Burgoon, Philip R O Payne, Randeep Jawa, Rebecca Erwin-Cohen, Rena Patel, Richard A Moffitt, Richard L Zhu, Rishi Kamaleswaran, Robert Hurley, Robert T Miller, Saiju Pyarajan, Sam G Michael, Samuel Bozzette, Sandeep Mallipattu, Satyanarayana Vedula, Scott Chapman, Shawn T O'Neil, Soko Setoguchi, Stephanie S Hong, Steve Johnson, Tellen D Bennett, Tiffany Callahan, Umit Topaloglu, Valery Gordon, Vignesh Subbian, Warren A Kibbe, Wenndy Hernandez, Will Beasley, Will Cooper, William Hillegass, Xiaohan Tanner Zhang, Leyna Aragon, Etienne Carignan

Affiliations

¹ Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
² Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York.
³ Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.
⁴ Biostatistics Program, Department of Preventive Medicine and Biostatistics, National Institute of Diabetes and Digestive and Kidney Diseases, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
⁵ Nephrology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
⁶ Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
⁷ Division of Data Driven and Digital Medicine, Department of Medicine, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
⁸ Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁹ Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, New Jersy.
¹⁰ Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania.
¹¹ Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York.
¹² Northport VAMC, Northport, New York.
¹³ Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan.
¹⁴ Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, Oregon.
¹⁵ Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
¹⁶ Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
¹⁷ Division of Nephrology, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, Michigan.

PMID: 40762975
PMCID: PMC12537286 (available on 2026-10-01)
DOI: 10.2215/CJN.0000000773

Abstract

Key Points:

Baseline CKD, even mild, is associated with a higher risk of long coronavirus disease (COVID) in patients with acute severe acute respiratory syndrome coronavirus infection.
Among those without CKD at baseline, Long COVID is associated with a higher risk of developing new CKD and faster kidney function decline.
Associations between Long COVID and CKD/kidney function decline persist after matching, adjustment, and accounting for the competing risk of death.

Background: Among patients with acute coronavirus disease-19 (COVID-19), the association of CKD and Long COVID has not been reported in large multicenter cohorts.

Methods: This study used data from 59 health care systems across the United States, in the National Clinical Cohort Collaborative COVID enclave, to analyze the relationship between CKD and Long COVID among adults diagnosed with acute COVID-19 between October 2021 and September 2023. We conducted two main analyses. First analysis: we tested if baseline CKD (eGFR <60 ml/min per 1.73 m² or diagnostic code) or baseline ESKD are risk factors for Long COVID (identified using ICD-10-CM code U09.9). We secondarily assessed associations between baseline mild CKD (Stage 3a, eGFR 45–59 ml/min per 1.73 m²) and Long COVID. Second Analysis: among patients without baseline CKD/ESKD, we examined if incident CKD/ESKD and eGFR decline (≥20% in 1 year) were associated with Long COVID. We used propensity score matching for demographics and data contributing site, with models adjusted for risk factors and competing risk of death. All outcomes were evaluated within a 365-day follow-up period from the onset of acute COVID-19.

Results: First analysis: From an unmatched cohort of 2,385,20 patients with acute COVID-19, those with baseline CKD/ESKD had a higher risk of Long COVID (adjusted subdistribution hazard ratio [sHR], 1.13; 95% confidence interval [CI], 1.09 to 1.18) after matching. A similar risk was noted even among those with mild CKD (sHR, 1.15; 95% CI, 1.05 to 1.25). Second Analysis: Among patients with acute COVID-19 and without baseline CKD/ESKD, Long COVID was associated with incident CKD/ESKD (sHR, 1.65; 95% CI, 1.51 to 1.81) and 20% or greater eGFR decline (sHR, 1.21; 95% CI 1.04 to 1.40) within 1 year.

Conclusions: CKD, even mild, was associated with an higher risk of Long COVID. Among those without baseline CKD, Long COVID was associated with incident CKD and eGFR decline.

Keywords: CKD; COVID-19.

PubMed Disclaimer

Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/CJN/C372.

References

1. (WHO) WHO. Post COVID-19 Condition (Long COVID); 2022. Accessed January 12, 2024. https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-cond...
1. Sedgley R, Winer-Jones J, Bonafede M. Long COVID incidence in a large US ambulatory electronic health record system. Am J Epidemiol. 2023;192(8):1350–1357. doi: 10.1093/aje/kwad095 - DOI - PubMed
1. Global Burden of Disease Long COVID Collaborators, Wulf Hanson S Abbafati C Aerts JG, et al. Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA. 2022;328(16):1604–1615. doi: 10.1001/jama.2022.18931 - DOI - PMC - PubMed
1. Mantovani A Morrone MC Patrono C, et al. Long Covid: where we stand and challenges ahead. Cell Death Differ. 2022;29(10):1891–1900. doi: 10.1038/s41418-022-01052-6 - DOI - PMC - PubMed
1. Sneller MC Liang CJ Marques AR, et al. A longitudinal study of COVID-19 sequelae and immunity: baseline findings. Ann Intern Med. 2022;175(7):969–979. doi: 10.7326/M21-4905 - DOI - PMC - PubMed

Grants and funding

U54GM104942-05S2, U54GM115458/GM/NIGMS NIH HHS/United States

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- Wolters Kluwer
Research Materials
- NCI CPTC Antibody Characterization Program
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

The Association of Long COVID and CKD: Findings from the National Clinical Cohort Collaborative

Collaborators

Affiliations

The Association of Long COVID and CKD: Findings from the National Clinical Cohort Collaborative

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous